title: Characterization of refractory port-related blood stream infections in intestinal failure patients on parenteral nutrition.
abstract: OBJECTIVE
  Parenteral nutrition is life-saving for patients with severe intestinal failure. Line-related blood stream infection is the most frequent complication and strategies have been developed to sterilize central lines. Nevertheless, failures of attempted sterilization are not well understood.
  
  
  METHODS
  19 ports were explanted from 19 patients receiving parenteral nutrition because of port-related blood stream infection and failed sterilization, defined as a) recurrence of the same organism after a recent sterilization attempt <90 days), b) recovery of the causative organism after 10 days of proper antibiotic therapy or c) insufficient clinical improvement. Port chambers were opened and swabs were examined by culture.
  
  
  RESULTS
  Pathogens resembled those typically found in successfully treated line-related blood stream infection. Despite proper therapy for a median of 6.5 days the same pathogen was recovered from 18/19 chambers. In 9/19 chambers visible debris were found, from which the pathogen could be cultured.
  
  
  CONCLUSIONS
  Infected debris or infected biofilms in the chamber are the reason for failure to sterilize a port. Lock techniques, single lumen tunneled catheters or in certain settings the exchange of only the port chamber may be approaches to prevent, circumvent or treat failures of attempted sterilization of an infected port system.
authors.affiliation: 1st Medical Department, University of Tübingen, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Schäffler
authors.forename: A M
authors.initials: AM
authors.lastname: Daraban
authors.forename: S
authors.initials: S
authors.lastname: Roggenbrod
authors.forename: U
authors.initials: U
authors.lastname: Schumacher
authors.forename: A
authors.initials: A
authors.lastname: Königsrainer
authors.forename: M
authors.initials: M
authors.lastname: Gregor
authors.forename: G
authors.initials: G
authors.lastname: Lamprecht
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000209:etiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications* / Q000451:nursing*; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects*; D055815:Young Adult